More support needed to ensure abortion access in Cambodia

A provider’s training and attitudes about abortion can affect access to care and the quality of services.

Having a progressive abortion law is not enough to improve women’s access to safe abortion services. Legislative reform must be coupled with efforts to make sure providers have the information and tools they need to make services available.

This is one of the messages gleaned from recent Ipas-funded research. Ipas collaborated with the Cambodian National Institute of Public Health and the National Reproductive Health Program to produce the report, “Don’t Ask, Don’t Tell: Breaking the silence surrounding abortion among maternity care providers in Cambodia.” The paper was presented at the Asia Pacific Conference on Reproductive and Sexual Health in late 2005. 

In 1997, Cambodia enacted a new abortion law that made services permissible on demand during the first three months of pregnancy. But the “Don’t Ask, Don’t Tell” study reveals that there is still much to be done to properly train and equip health-care professionals to provide abortion care.

Although national standards and guidelines for postabortion care and termination of pregnancy are in development, the lack of guidance and support means that safe abortion care remains a privilege rather than a right for most women in Cambodia. According to the 2000 Cambodian demographic and health survey, approximately a third of abortions are unsafe (usually taking place in someone’s home). Only 27 percent occur in the public sector.   

Among the surveyed providers, there was a significant amount of uncertainty and discomfort with abortion care, which can adversely affect the quality of care women receive. Twenty-eight percent of the respondents, who worked at public hospitals or health centers, said they were unsure about the current law. Almost half thought they were breaking the law or guidance about abortion.

However, the study shows that health-care providers feel some obligation to meet the abortion needs of their patients. Sixty percent believed that providers have a duty to offer abortion regardless of their personal opinions — a positive trend as other countries are experiencing health-care workers’ increasing conscientious objection to abortion services. 

Despite uncertainty about the law and lack of public discussion about abortion, many of these providers had read about the law. Most had counseled a friend, relative or someone else with an unwanted pregnancy, and 15 percent had had a personal experience, either themselves or with a partner.

“Don’t Ask, Don’t Tell” is one of three studies designed to provide information for efforts to scale up Cambodia’s abortion services and to tackle its high maternal mortality rate. Finding out about providers’ own comfort levels and their abortion-related experiences or perceptions is key to promote access to safe abortion. Providers’ attitudes are a crucial factor in whether women get safe and nonjudgmental care. With this study, Ipas and its partners are better prepared to identify and counter the negative opinions that can impede abortion care even where it’s permitted under law.

For more information, contact:
Kirsten Sherk
Senior Associate, Media Relations
e-mail: sherkk@ipas.org
phone: 919.960.5612
fax: 919.929.0258